Higher
than expected blood pregnancy test levels (HCG) early in pregnancy can
suggest a multiple gestation, but the only way to confidently diagnose
multiple gestations is with an ultrasound exam. Transvaginal sonography,
as early as 6 weeks gestation, is used to diagnose multiple gestations.
Sometimes, as a pregnancy progresses, fetuses may be missed in higher
order multiples. Some quadruplet or quintuplet remain undiagnosed and
are first found at the time of delivery because latter ultrasound exams
create optical illusions making imaging more difficult.

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